摘要
目的：本研究通过对膀胱尿路上皮癌患者存档蜡块行免疫组化检测,分析肿瘤组织中survivin含量对膀胱尿路上皮癌患者生存率的影响。对包括survivin在内的可能影响膀胱尿路上皮癌术后预后的多因素进行Cox回归分析,筛选出危险因素,并计算出患者的预后指数。以期给病人术后随访、治疗提供个体化方案。
方法：收集我院既往膀胱尿路上皮癌术后病人资料,包括患者年龄、性别、发病类别(新发、复发、多次复发)、肿瘤形状、肿瘤数目(单发、多发)、肿瘤大小、肿瘤分级、分期,手术方式(经尿道膀胱肿瘤电切术、膀胱部分切除术、膀胱全切术)。检测患者存档蜡块中的survivin含量,并随访病人的生存时间及复发情况。膀胱尿路上皮癌组织中survivin的含量对患者生存率影响用Kaplan-Meier生存曲线估计、Log-rank检验。对多因素预后分析用Cox回归分析,根据多因素分析结果,建立预后指数模型。
结果：Survivin表达阳性的膀胱尿路上皮癌患者的总生存时间短于survivin表达阴性的膀胱尿路上皮癌患者(P=0.001<0.05)。影响膀胱尿路上皮癌患者长期生存的因素分别是患者的年龄(RR=1.116,P=0.002)、肿瘤的分期(RR=4.963,P=0.000)、肿瘤类别(RR=2.698,P=0.015)。根据预后指数的数值段将患者分为低危组、中危组和高位组3个预后组,3组患者中位生存时间分别为52、48、10个月。其两两比较差别有意义(P=0.000<0.05)。
结论：1、膀胱尿路上皮癌组织中survivin的检测对于膀胱癌患者的预后有一定的临床预测作用。Survivin表达阳性的膀胱尿路上皮癌患者的总生存期短于survivin表达阴性的膀胱尿路上皮癌患者。2、在影响膀胱尿路上皮癌术后患者生存时间因素中,患者的年龄还有肿瘤的分期、肿瘤的发病类别都是影响患者预后生存的危险因素。3、不同预后指数组别的患者的术后生存率的差别有统计学意义。患者的预后指数越高其生存时间越短。对这些因素的监测有利于患者的预后的预测以及对患者个体化治疗方案的选择有一定的指导作用。
Objective:To detect the relationships between the expression of survivin in bladder urothelial carcinoma tissue and cancer-specific survival by immunohistochemistry. And to blot the risk factors by analysis potentially risk factors which can result in cancer-specific death, to provide individual schedule for patients'follow-up and treatment.
Methods:Collect bladder urothelial carcinoma patients'information who underwent operation including gender, age, disease category (the initial, the recrudescent, the multiple recrudescent)、tumor sharp, tumor number(single, multiple), tumor size, tumor grade, tumor stage, operation mode (TURBT, partial cystectomy, cystectomy). Detect the expression of survivin in the paraffin block of bladder urothelial carcinoma patients and follow up the survival time and conditions of recurrence. Utilize Kaplank-Meier survival curve and Logrank analysis to estimate the relationships between the expression of survivin in bladder urothelial carcinoma tissue and cancer-specific survival. Utilize the regression analysis to analyze multiple factor and to establish prognosis index (PI) model according to the analytic result.
Results:Cancer-specific survival was shorter in those patients with survivin positive compared with those with survivin negative (P=0.001< 0.05); patients'age (RR=1.116, P=0.002), tumor stage (RR=4.963, P=0.000) and disease category (RR=2.698, P=0.015) were independently associated with poorer cancer-specific survival in bladder urothelial carcinoma patients. To divide patients into high risk class, midrange risk class and low risk class according to numerical value of PI. There was statistical significance among the three classes'survival median time (P=0.000< 0.05).their survival median time respectively were 52、48、10 months.
Conclusion:1. Survivin express has limited prognostic value in patients with bladder urothelial carcinoma, overall survival was shorter in those patients with survivin positive compared with those survivin negative.2. Age, tumor stage, disease category and tumor number were independently associated with poorer cancer-specific survival.3. The difference of prognosis index has statistical significance in patients with bladder urothelial carcinoma. The higher the prognosis index is, the shorter the survival time is. It is beneficial to detect these risk factors for follow-up of patients' prognosis and choice of individual treatment schedule.
引文
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